Assessment Of Psychosocial Factors Research Articles

Abstract MP69: The “Pressure” of Being an Adolescent in Palestine: Prehypertension and Hypertension Prevalence

Introduction: Prolonged exposure to geo-political violence and forced displacement has adverse health impacts, such as hypertension in Palestinian populations residing in Palestine. Over 27% of adults in Palestine are reported as hypertensive, yet there is limited knowledge of hypertension rates among Palestinian adolescents. This study assessed the relationship between refugee status and (pre)hypertension among Palestinian adolescents residing in Palestine. Hypothesis: We hypothesized refugees would demonstrate higher prehypertension (PHTN;121/<80 to 129/<80 mmHg) and hypertension (HTN; ≥130/ ≥ 80 mmHg) prevalence compared to non-refugees, after controlling for age and sex. Methods: This cross-sectional study was conducted among Palestinian adolescents residing in refugee camps, villages, and cities in Palestine. A random sample of adolescents was recruited through schools from November 2022 to January 2023. Anthropometric measurements including blood pressure (mmHg), heart rate (BPM), body fat (%), height (cm), body weight (kg) and survey questionnaires were collected. Ordinal regression models were used to assess the relationship between refugee status and (pre)hypertension while controlling for age and sex. Interaction effects were conducted to assess the relationship of refugee status by sex on (pre)hypertension. Results: A total of 706 Palestinian adolescents (refugees= 377, [39.4 % females, 60.6 % males] and non-refugees= 329 [39.9% females, 60.1% males]) aged 13-17 (median= 14 years) participated. The overall prevalence of PHTN and HTN was 52.5% and 28.7%, respectively. Refugees had a lower prevalence of PHTN [25.5% vs. 27.0%] and HTN [12.7% vs. 16.0%] compared to non-refugees, although confidence intervals overlapped. Overall, there was no association between refugee status and (pre)hypertension in unadjusted models, or models adjusting for age and sex [AOR 0.88; 95% CI= 0.65-1.20]. The distribution of percent body fat was higher for non-refugees [37%; 95% CI=21%-39%] compared to refugee groups [24%; 95% CI=18-31]. Interaction effect regression models showed an association between refugee status and (pre)hypertension among females. Among females, refugees had 1.75 [95%CI=1.04-2.95] times higher odds of (pre)hypertension than non-refugees after adjusting for age. Conclusions: The overall PHTN and HTN prevalence for this participant sample is four and seven times the global average, denoting an alarming public health burden. Future studies should consider the assessment of psychosocial factors that may drive cardiovascular health disparities in adolescent Palestinians.

Assessing Psychosocial Readiness for Gene Therapy in Sickle Cell Disease: A Consensus Statement

Introduction: Scientific evidence regarding the efficacy and safety of gene therapy for sickle cell disease (SCD) is growing and clinical trials are increasingly available to patients. As a result, clinical trial teams are now challenged with considering the ways in which psychosocial factors may affect patient decisions about pursuing gene therapy and how pre-gene therapy psychosocial functioning may influence long-term patient outcomes. Although data specific to gene therapy for SCD are currently limited, research in other chronic illness populations undergoing major medical procedures (e.g., solid organ and stem cell transplants) suggest that premorbid psychosocial functioning affects decision-making and post-procedure outcomes. Clinical observations support the relevance of considering psychosocial readiness for curative therapies in patients with SCD but there is a lack of guidance regarding how to carry out such evaluations. Therefore, the NHLBI's Cure Sickle Cell Initiative (CureSCi) formed the Patient Readiness and Resilience Working Group to develop consensus recommendations regarding the assessment of psychosocial readiness in the context of gene therapy for SCD. Methods: The NHLBI CureSCi Patient Readiness and Resilience Working Group was formed in September 2020 and consisted of 10 members including mental health clinicians, researchers, and patients and caregivers. The working group met from 2020-2022 to develop best practice recommendations for the assessment of patient readiness and resilience prior to gene therapy for SCD. Recommendations were developed based on available scientific evidence, expert clinical guidance, review of strategic planning documents, and consultation with CureSCi subcommittees and working groups representative of patient, advocate, clinician, and researcher perspectives. A draft of the consensus recommendations was released for public comment in 2022 and final revisions were completed in early 2023. Results: The CureSCi Patient Readiness and Resilience Working Group reached consensus regarding recommended practices for conducting pre-gene therapy assessments of patient readiness in SCD. The working group developed a recommended workflow for assessing patient readiness, including an institutional self-assessment of readiness to support patients' mental health and address psychosocial barriers to care, brief screening of cognitive functioning and health literacy, patient education about clinical trials and gene therapy, assessment of patient readiness and resilience followed by interventions to address areas of concern, and informed consent. Detailed guidance was developed across four primary domains: 1) Effective education delivery; 2) Evaluation of knowledge and understanding; 3) Evaluation of interest and motivation; and 4) Evaluation of psychosocial risk and resilience factors. The working group created a guide to support implementation of pre-gene therapy assessments, which outlines evidence-based strategies for effective patient education, recommended assessment tools, and sample clinical interview questions. Conclusions: As gene therapy for SCD becomes increasingly available to patients, there is a growing need to be prepared to consider readiness and resilience factors that could affect patient well-being before, during, and after treatment. This CureSCi working group developed a set of consensus recommendations regarding the assessment of psychosocial factors in the context of gene therapy for SCD. A thorough guide was developed to aid in implementation of pre-gene therapy assessments across a range of institutional settings. The presentation will review consensus recommendations, describe practical strategies for conducting assessments, and discuss areas for future research.

Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN.

To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.

Teaching SSHADESS Versus HEADSS to Medical Students: An Association With Improved Communication Skills and Increased Psychosocial Factor Assessments.

The most recent Bright Futures edition describes both the HEADSS (Home, Education, Drugs, Sexuality, Safety) and the strength-based SSHADESS (Strengths, School, Home, Activities, Drugs, Emotions, Sexuality, Safety) frameworks for conducting an adolescent psychosocial history. We found limited research comparing the effectiveness of these 2 frameworks. Our study objective was to examine whether teaching medical students SSHADESS versus HEADSS is associated with increased communication skills and/or completion of the psychosocial assessment. In this retrospective cohort study of pediatric clerkship students at New York University Grossman School of Medicine, we collected data from observer (faculty, fellow, and resident) and standardized patient (SP) assessments during Objective Structured Clinical Examinations. Primary outcomes were observer and SP-rated usage of communication skills. Secondary outcomes were observer-rated assessment of 6 psychosocial factors. Ourpredictor variable was whether students were taught HEADSS (11/2015-10/2016) or SSHADESS (11/2016-10/2017). We used Fisher's exact tests and then logistic regressions to adjust for pediatrics clerkship timing and baseline communication skills. About 200 students were assessed (n=97 HEADSS cohort, n=103 SSHADESS cohort). In adjusted analyses of observer scores, the SSHADESS cohort was more likely to use all communication skills (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] 1.7-6.3]) and assess all psychosocial factors (aOR 1.9, 95% CI 1.01-3.4).There was no significant difference in SP communication scores. Teaching SSHADESS was associated with higher observer-rated communication skills scores and improved completeness in assessment of psychosocial factors. Future work should examine the efficacy of SSHADESS through workplace-based assessments and 360 degree assessments from adolescent patients.

Interactive associations between abstinence plans and romantic partner conflict and support with cigarette smoking

BackgroundWhile most individuals who smoke cigarettes desire to quit, quit motivation can change daily and sustained abstinence is rarely achieved in quit attempts. Assessment of psychosocial factors that moderate associations between daily abstinence intentions and smoking behavior is necessary to inform effective cessation efforts. MethodsA secondary analysis was conducted using data from a 28-day ecological momentary assessment study among individuals who smoke and who were not actively planning a long-term quit attempt (N = 81 individuals; N = 1585 days). We examined main effect and interaction associations between primary predictors (daily abstinence plans and within- and between-person estimates of perceived romantic relationship conflict and support) and daily number of cigarettes smoked, as well as baseline emotion regulation difficulties as a moderator of these associations. ResultsSmoking was reduced on days with an abstinence plan (β=−0.57,p<.001), especially among individuals with lower average levels of conflict (plan × between-person conflict interaction: β=0.98, p < .001), and higher average levels of support (plan × between-person support interaction: β=0.26, p < .001). Additionally, smoking was increased on days when participants had higher levels of conflict than usual (β=0.07, p < .01), but only on days when participants did not have a plan (plan × within-person conflict interaction:β=-0.10, p < .05). Emotion regulation difficulties did not moderate any associations. ConclusionThis study adds to the literature on the influence of negative aspects of social experience on smoking behavior. Further, the present study underlines the importance of assessing the influence of both positive and negative aspects of – and within- and between-person differences in – social experiences.

Assessment of Psychosocial Factors in Brazilian Dentists Facing Risk of SARS-CoV-2 Infection in the Public and Private Sectors.

Dentists are at high risk of SARS-CoV-2 infection due to their close proximity to patients. Thus, the fear of contamination or spreading the virus to family members, coupled with financial need, can lead professionals to experience significant overload and psychological suffering. We investigated the perceptions of dental professionals in the public and private sectors regarding fear and anxiety related to patient care and the risk of infection in the face of the COVID-19 pandemic. Based on the previous literature, we interviewed 302 dentists online using sociodemographic and professional questions. Among the professionals evaluated, 80.8% had suspended their activities for some time, 74.8% were afraid of infection at work, 86.1% feared transmitting the virus to their families, 30.1% had already been infected, 54% felt afraid when they heard the news of death caused by SARS-CoV-2, and 63.9% reported having the protective knowledge necessary to avoid infection. Dentists who worked only in the public sector and those who worked in both sectors were more afraid of being infected than professionals who worked only in private offices. Our results highlight the impact of the COVID-19 pandemic on emotional health in dentists. This study highlights the need for more support in the psychosocial field to enable dentists to overcome difficulties and maintain the provision of good dental care for the population. Continuing education should update professions with the requisite scientific and clinical knowledge to face the pandemic and achieve greater reflection on their role within this new context to improve their professional and emotional performance.

The Psychosocial Risk Factors of Low Back Pain in 10–13-Year-Old Children

Research background. Even 70% of population in industrialized countries report low back pain (LBP). LBP usually appears in early adolescence, and it is as common in late adolescence as in adulthood. Low back pain reported in childhood is a predictor of LBP in adulthood. It is widely accepted that back pain is a multidimensional disorder with physical, lifestyle and psychosocial factors related to the development and maintenance of adolescent back pain. So far, no definitive conclusion has been made on the nature and interaction of these factors. The aim of the research was to measure the prevalence of LBP and define the relationship among psychosocial factors and back pain. Research methods. The study included 193 respondents: 103 girls and 90 boys aged from 11 to 13 years of age. We conducted a cross-sectional study using Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) to assess psychosocial factors. The prevalence of back pain was assessed by a questionnaire. Research results. The life time prevalence of back pain is 38.9%. Girls (46.6%) experience back pain more often than boys (30%). The assessment of psychosocial factors identified that majority of children 73.6% had no difficulties. Psychosocial difficulties were more common among boys (18.8%) than girls (7.8%). Emotional problems were assessed in 15% of respondents and peer problems in 31.6%. Conclusions. Less than half of children have experienced low back pain at least once in their life. Girls experienced back pain more often than boys. The prevalence of back pain is increasing with age. Reliable evidence was obtained that children who experience, or are likely to experience, psychosocial problems suffer from back pain more frequently.Keywords: children, low back pain, psychosocial factors.

Anxiety and health-related quality of life after cardiac surgery.

IntroductionThe aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL).Material and methodsOne hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up.ResultsIt was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety.ConclusionsThis study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.

Assessment of anxiety and health-related quality of life in patients with lower extremity peripheral arterial occlusive disease.

IntroductionThe aim of this study was to investigate the effect of chronic occlusive vascular disease on anxiety with adverse outcome with health-related quality of life (HRQoL).Material and methodsThree hundred and thirty-five patients who were treated for peripheral arterial occlusive disease were enrolled in this study. 187 patients who had undergone percutaneous transluminal angioplasty and 148 patients who had one or more surgical revascularizations enrolled in the study. Mean age of the patients was 62.6 ±10 years. Two hundred and eighty-nine patients were male, 46 patients were female. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 335 patients filled out the SF-36 and STAI, and 304 patients (90.7 % of the series) filled them out at 6-month follow-up.ResultsThere was no mortality and no significant morbidity after vascular interventions in the series. Significant improvement was found in two of eight health domains. The score of social functioning increased to 60.4 from 52.6 (p < 0.03) and general health perception increased to 75.1 from 60.5 (p < 0.04) at 6-month follow-up. The two STAI sub-scores, the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T) were found high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was no significant decrease of the levels of anxiety.ConclusionsThis study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status in patients suffering from lower extremity peripheral arterial occlusive disease.

Assessment of psychosocial factors in office and operational groups of employees of a Regional Electricity Distribution Company in Iran – A case study

BackgroundMany studies have shown an association between unfavorable psychosocial factors and personal and organizational outcomes. In recent years, psychosocial issues have received top priority between work environment factors. This study aimed to provide a first insight into psychosocial stressors in electricity distribution industry in Iran and compare the psychosocial factors between two job categories of office and operational workers. MethodsThe study population was employees of an electricity distribution company in Iran. The standard Persian medium size of Copenhagen psychosocial questionnaire (COPSOQ) was used in this study to measure psychosocial factors. The questionnaire comprised 5 domains and 26 scale. Mean and standard deviation of each scale and domain were obtained for office and operational workers separately and the results were compared. ResultsHigher scores were obtained in the domain of "job demands" of operational workers. In the domain of "job contents", More Unfavorable condition was obtained for office workers. No significant difference was seen in the domain of "inter personal relationship". More unfavorable scores for operational workers were obtained in the domain of work-individual interface" in a univariate analysis, but after adjusting the confounders including age, type of employment, directorship status and income, multivariate analysis did not show any significant difference. In the domain of "individual Health and well-being", higher scores were obtained for operational workers. ConclusionThis study provides support regarding the differences of psychosocial working environments between office and operational workers in electrical distribution industry. It is worth considering these differences of psychosocial factors at employees scheduling.

Assessment of psychosocial factors at work: A systematic review

Abstract This paper presents a systematic review of Brazilian and international studies on the assessment of psychosocial factors, published between 2009 and 2015, with emphasis on the analysis of assessment instruments. One of the main interests of this review was to identify, in the published articles, the use of principles of Positive Psychology in the analysis of factors of prevention, promotion and health protection of workers. A total of 5,724 articles were found. Articles that were repeated or not written in Portuguese, English or Spanish were excluded. Thus, after analysis, 410 articles remained. Of these, 69 articles that dealt directly with the evaluation of psychosocial factors at work were selected. Most studies address the pathogenesis of psychosocial factors, but there is increasing number of studies that combine the analyses of pathogenic factors with motivational factors in health promotion and in the study of preserved positive aspects. We found that although the findings indicate an incipient movement concerning some protective factors (social support, creativity, engagement, etc.), there are still few studies in the Positive Psychology approach. We suggest that further studies test integrative theoretical models or stressors and motivational factors to deepen the understanding of the protective factors and positive aspects associated with psychosocial factors at work.

Cortisol profiles differ by race/ethnicity among young sexual minority men

Much of the extant scientific research examining hypothalamic-pituitary-adrenal (HPA)-axis functioning is conducted among White heterosexuals. Very little research examines HPA-axis functioning between different minority groups. Individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect HPA-axis functioning. In the current study, we examined diurnal cortisol rhythm in young White gay men (WGM) compared to young Black gay men (BGM). The sample consisted of 70 healthy gay men (mean [SD] age=22.9 [3.2]: 68% White and 38% Black) who collected four saliva samples daily for five days. Repeated measures analysis of covariance and post-hoc tests revealed that BGM had higher cortisol levels than WGM in the evening. Secondary analyses revealed no significant group differences for the cortisol awakening response or systemic output throughout the day. However, BGM compared to WGM had a lower drop from peak (morning) to lowest (evening) cortisol concentrations. Taken together, these findings reveal a flatter diurnal cortisol rhythm among BGM compared to WGB. The functional significance of these preliminary findings must be explored further with assessment of psychosocial factors among sexual minorities at the intersection of multiple identities. In summary, we expand health disparities research aimed at delineating sexual minority and race/ethnic variation in stress physiology.

Assessment of psychosocial factors and distress in women having adjuvant endocrine therapy for breast cancer: the relationship among emotional distress and patient and treatment-related factors.

PurposeThe aims of this study were to comprehensively describe the psychosocial and medical characteristics of women who initiated tamoxifen or aromatase inhibitors for breast cancer and to compare levels of emotional distress according to their medical (tumor demographics, treatment type, treatment duration) and psychosocial (self-esteem, perceived social support, sociodemographic) characteristics.MethodsA total of 104 women currently receiving tamoxifen or aromatase inhibitors was recruited from outpatient clinics and they were asked to complete self-report questionnaires including the Rosenberg Self-Esteem Scale, the Multidimensional Scale of Perceived Social Support and the Hospital Anxiety and Depression Scale during their routine follow-up. Psychosocial and medical characteristics of the patients were first described and subsequently the score of emotional distress was compared with these.ResultsThe patients’ mean age was 52.49 ± 10.30 and they were being treated for an average of 24.3 months. Out of the patients’ characteristics, educational and marital status, level of perceived social support and self-esteem were all significantly related with emotional distress. As for medical variables, the score of distress was relatively higher among patients in the first 2 years of their treatment than the patients who were in the second to fifth years of treatment, but this was not statistically significant.ConclusionsGiven the results of this study, it appeared that patient variables, rather than the medical or treatment characteristics, were related with emotional distress in women undergoing endocrine treatment. For that reason it is critical that medical staff are aware of patient factors that relate to distress during a long period of adjuvant endocrine therapy.

Assessment of psychosocial factors and predictors of psychopathology in a sample of heart transplantation recipients: a prospective 12-month follow-up.

In the last decades, researchers of heart transplantation (HT) programs have attempted to identify the existence of psychosocial factors that might influence the clinical outcome before and after the transplantation. The first objective of this study is the prospective description of changes in psychiatric and psychosocial factors in a sample of HT recipients through a 12-month follow-up. The second goal is to identify predictors of psychopathology 1 year after HT. Pretransplant baseline assessment consisted of clinical form; Hospital Anxiety and Depression Scale (HADS); Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Structured Clinical Interview; Coping questionnaire (COPE); Five Factors Inventory Revised; Apgar-Family questionnaire and Multidimensional Health Locus of Control (MHLC). The assessment 1 year after HT consisted of HADS, COPE, Apgar-Family and MHLC. The sample included 78 recipients. During the waiting list period, 32.1% of them had a psychiatric disorder; personality factors profile was similar to the general population, and they showed adaptive coping strategies. Some changes in psychosocial factors were observed at 12 months after the surgery: lower scores of anxiety and depression, less necessity of publicly venting of feelings and a trend to an internal locus of control. Neuroticism and Disengagement pre-HT were predictors of psychopathology in the follow-up assessment. Pretransplant psychosocial screening is important and enables to find out markers of emotional distress like Neuroticism or Disengagement coping styles to identify patients who might benefit from psychiatric and psychological interventions. Successful HT involved some positive changes in psychosocial factors 12 months after the surgery beyond physical recovery.

Epidemiological Study for Evaluation of Etiology and Risk Factors in Patients with Low Back Pain

Introduction To study the epidemiology, etiology and risk factors among patients with low back pain. In addition, it includes evaluation of efficacy of protocol suggested by American College of Physician (ACP) and American Pain Society (APS) 2007 in Indian population. Finally, to develop a possible protocol for India, in managing patients with low back pain. Materials and Methods Epidemiology of patients with low back pain which includes demographic variables such as age, gender, education, occupational history, body mass index (BMI), diet habits, smoking, alcohol intake, comorbid conditions, life style factors, family history, and finally psychosociological factors by fear avoidance Belief Questionnaire (FABQ) were recorded. Focused history, examination, stratification, and further evaluation were done in accordance with protocol as suggested by ACP/APS 2007. Each patient was followed up monthly for 6 months to assess the outcome of stratification and treatment modalities advised. However, apart from pharmacological therapy, exercise therapy alone was used in both acute and chronic cases. Transition among stratified groups was evaluated. Results [Table: see text] Total number of patients evaluated were 506. Mean age of presentation was 41.15 ± 11.21 years in females and 39.13 ± 12.76 years in males. Most common age group involved were 36 to 40 years. Gender distribution shows that females were 52.6% and males were 47.4%. Literates were 68.4%. Occupation involving prolonged sitting account for majority of cases with 45.3%. Prolonged static posture such as sitting at work period, bending, and lifting activities were significantly ( p &lt; 0.05) associated with low back pain. However, no association was found with BMI, diet habits, smoking, life style factors. Mean FABQ score was more among chronic group compared with acute group but scores in patients with progression from acute to chronic were not significant. Etiology includes nonspecific back pain in 51.9%, intervertebral disc prolapse in 23.1%, spondylolisthesis in 10.4%, spinal canal stenosis in 4.7%, osteoporotic fractures in 3.7%, tuberculosis and inflammatory spondyloarthritis in 2.1% each, tumor conditions account for 1.3%, and finally 0.1% pyogenic discitis. Total 82.6% among category I, 100% of category II, 95.3% among category III were correctly identified based on approach used by protocol. However, the transition among categories was significant; 5.3% were lost to follow-up. Outcome analysis shows that 88.7% were symptom free and 11.3% had recurrence rate at the end of 6 months. Conclusion Low back pain continues to be an enormous social, psychological and financial problem with many speculated risk factors with none being convincible till time. From the present study, epidemiological profile of Indian population was depicted. Etiological diagnosis in low back pain patients still includes nonspecific back pain, a leading cause with 51.9%. However, it is a diagnosis of exclusion. Risk factor analysis shows that prolonged static postures at work place, activities involving bending and lifting were found to be statistically significant. In addition, using FABQ in assessment of psychosocial factors in low back pain is necessary and helpful in managing patients. However, the efficacy needs to be further evaluated. Regarding the evaluation of guidelines and its applicability, it is not advisable to use in Indian population. However, it forms a blueprint on which modifications such as investigating to rule out tuberculosis and spondylolisthesis in Indian population will be helpful before labeling any case as nonspecific back pain. Disclosure of Interest None declared References Solomen L, Warwide D, Nayagam S. Apley's System of Orthopedics and Fractures. 9th ed. London, UK: Hodder Arnold Publication; 2010:974 Secer M, Nacar OA, Muradov MJ, et al. Nonspecific low back pain in a group of young adult men. Turk Neurosurg 2011;21(2):135–139 Chou R, Qaseem A, Snow V, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147(7):478–491 Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in workage adults in rural North India. Indian J Med Sci 2003;57(4):145–147 Hult L. Cervical, dorsal and lumbar spinal syndromes; a field investigation of a non-selected material of 1200 workers in different occupations with special reference to disc degeneration and so-called muscular rheumatism. Acta Orthop Scand Suppl 1954;17:1–102 Nachemson AI. The lumber spine, an orthopaedic challenge. Spine 1976;11:59–71 Borenstein DG. A clinician's approach to acute low back pain. Am J Med 1997;102(Suppl 1A):16S-22S Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992;268(6):760–765 Deyo RA, Bass JE. Lifestyle and low-back pain. The influence of smoking and obesity. Spine 1989;14(5):501–506 Jones GT, Johnson RE, Wiles NJ, et al. Predicting persistent disabling low back pain in general practice: a prospective cohort study. Br J Gen Pract 2006;56(526):334–341

COPSOQ International Network: Co-operation for research and assessment of psychosocial factors at work

Abstract COPSOQ is a comprehensive questionnaire on psychosocial factors at work which is internationally widely used since approx. 10 years for risk assessments in organisations. The International COPSOQ-Network was established in 2009 by scientific and empirical users of the COPSOQ. Main aim is the international scientific exchange concerning the use of COPSOQ. A second goal lies in the coordination of research and further development of the questionnaire (content and measurement qualities), to facilitate international comparison studies. Further information: www.copsoq-network.org

The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery

BackgroundPsychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery.MethodsAfter informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths.ResultsDuring a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained.ConclusionsOur results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.

Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: Four quasi-experimental single-subject studies

The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0–10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery☆

Our aim was to prospectively examine the association of psychosocial factors with adverse outcome after cardiac surgery. One hundred and eighty cardiac surgery patients were enrolled and contacted annually by mail. Depression [Beck depression inventory (BDI)], anxiety [state anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-S) and trait anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-T)] were investigated annually, social support, negative affectivity, social inhibition (SI), illness intrusiveness, self-rated health and sleeping disorders were investigated by standardized tests at the second and fifth year. The end-point was the major adverse cardiac and cerebrovascular event (MACCE) including death. Twenty-eight (15.5%) patients died by the end of the fifth year. At the end of the second and fifth years, 146 (81.1%) and 118 (65.5%) patients fulfilled the tests, respectively. At the end of the second year after adjustment for medical and perioperative factors worse self-rated health [adjusted hazard ratio (AHR): 0.67, P=0.006], sleeping disorders (AHR: 1.14, P=0.001), higher illness intrusiveness (AHR: 1.03, P=0.018), higher BDI (AHR: 1.12, P=0.001), STAI-S (AHR: 1.09, P=0.001) and higher STAI-T scores (AHR: 1.08, P=0.002) showed higher risk for MACCE. Significant individual elevation in scores of sleeping disorders, illness intrusiveness and SI were observed over the three-year period in the MACCE group. Assessment of psychosocial factors could help in identifying patients at high-risk for MACCE after cardiac surgery.

Evaluation of Pain Measurement Practices and Opinions of Peripheral Nerve Surgeons

The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n = 133). Seventy members responded to the survey (49%) and 59 surgeons completed the survey (44%). For patients referred for motor or sensory dysfunction, 31 surgeons (52%) indicated that they always formally assess pain. In patients referred for pain, 44 surgeons (75%) quantitatively assess pain using a verbal scale (n = 24) or verbal numeric scale (n = 36). The most frequent factors considered very important in the development of chronic neuropathic pain were psychosocial factors (64%), mechanism of injury (59%), workers' compensation or litigation (54%), and iatrogenic injury (48%). In patients more than 6 months following injury, surgeons frequently see: cold sensitivity (54%), decreased motor function (42%), paraesthesia or numbness (41%), fear of returning to work (22%), neuropathic pain (20%), and emotional or psychological distress (17%). Only 52% of surgeons who responded to the survey always evaluate pain in patients referred for motor or sensory dysfunction. Pain assessment most frequently includes verbal patient response, and assessment of psychosocial factors is rarely included. Predominately, patient-related factors were considered important in the development of chronic neuropathic pain.